Abstract 87: Population-Level Analysis of the Impact of SAMMPRIS on Intracranial Atherosclerosis Management

Abstract

Introduction: Released in 2011, the SAMMPRIS trial found significantly lower rates of stroke or death in patients with symptomatic intracranial atherosclerotic disease (sICAD) treated with medical management (MM) vs. percutaneous angioplasty and stenting (PTAS), 5.8% vs. 14.7%. However, the intensity with which MM was pursued has called into question the generalizability of the study. We report temporal trends in treatment for sICAD and 30-day event rates in a state-wide cohort, spanning the pre- and post-period of the SAMMPRIS trial. Methods: Using the Healthcare Cost and Utilization Project database on all discharges from acute care hospitals in Florida (2005-2014), we identified patients admitted for sICAD (defined as ICAD with TIA or stroke), and PTAS or angioplasty alone (AA). Patients were excluded for any diagnosis of ICH, SAH, AVM, aneurysm or trauma. Results: Among 8,745 patients with sICAD, 541 (6.2%) were treated with PTAS and 230 (2.6%) with AA. The mean(SD) age was 74±13 years, 52% were female, and 60% were white, 24% black and 13% Hispanic. 22% of patients were smokers, 43% had diabetes, and 86% HTN. All patients carried a diagnosis of dyslipidemia. Over the 10-year period, the number of patients diagnosed with sICAD increased; PTAS and AA treatments increased until 2011 and then decreased (Figure). 30-day rates of stroke, hemorrhage or death were comparable in the PTAS vs. AA groups (15.9% vs. 19.5%, p=0.24), and significantly lower in sICAD patients treated without PTAS or AA (6.0%, p<0.0001 vs. both PTAS and AA). Conclusion: Analysis of population-level data demonstrates reduction in the use of PTAS and angioplasty coinciding with the release of SAMMPRIS. Importantly, 30-day event rates for patients with sICAD treated with MM were comparable to the low rates achieved in the trial.